The concept of telemedicine — a doctor-patient consultation conducted remotely via technology — was once thought of as a solution for providing rural communities with health care. Telemedicine has come to include phone calls, text messages, and video and audio components, explains Innovations Manager Jessica Zhang at NewYork-Presbyterian. Now telemedicine is enabling NYC residents to deal with questions about health issues in innovative ways:

• In the ER — For non-life-threatening situations that may bring people into emergency rooms, telemedicine can reduce waiting time. As an example, Zhang said, someone who gets a cut from a pedicure can be seen quickly in the ER using telemedicine. By zooming in on a patient with a hi-res camera, physicians on site or at a related hospital can make a recommendation for treatment.

• Urgent care — Telemedicine could replace certain types of visits to urgent care locations. Some conditions that physicians can examine visually – eye problems, rashes — people can do from home through an app. “I used it for myself in February when I thought I had the flu,” said Zhang. “A physician asked me to describe my pain, asked me to push on certain areas and did the entire exam virtually.” The doctor was then able to prescribe medication for her through the app.

In January and February 2018, NewYork-Presbyterian started a kiosk program with Duane Reade/Walgreens in Manhattan and Brooklyn. The program was “rolled out in phases,” said Zhang. There are now six such kiosks, equipped with an HIPAA-compliant internet connection, high-definition video cameras, forehead thermometers, blood-pressure cuffs and pulse oximeters that measure the amount of oxygen in the body. The busiest kiosk, at 40 Wall Street, has had 50-60 consultations to date, according to Zhang. (All patients who use NewYork-Presbyterian’s telemedicine platform, NYP OnDemand, are evaluated and treated by board-certified emergency medicine physicians.)

At this time of year, telemedicine kiosks may be helpful for dealing with heat-related illness or dehydration in young children and the elderly that can be addressed remotely by board-certified ER doctors (see box).

• Virtual visits — includes primary care as well as outpatient follow-up visits after surgery or hospitalization. Patients can have a FaceTime visit with physicans without leaving home.

• Second opinion program — The program reviews medical charts and puts patients in touch with NY-Presbyterian specialists. “We found that some of these cases result in a different course of treatment,” said Zhang.

Zhang also mentioned other ways in which telemedicine can help patients. In emergency rooms in outer NYC boroughs that may not have a full complement of specialists — where one would otherwise, for instance, “have to wait for a psychiatrist to come on site,” says Zhang, “now we can connect that emergency room with a specialist” remotely.

And for critical cases involving mobile stroke units — ambulance vans with CT scanners — telemedicine can “connect stroke patients with neurologists to decide [whether] to administer medications while you’re en route to the hospital,” says Zhang. “Time is of the essence” in treating strokes, she adds — “you can get a quick physician consultation before the patient gets to the hospital. You can make that decision about a life-saving treatment.”

There are medical emergencies for which telemedicine is NOT recommended — chest pain, trouble breathing, severe abdominal pain, heavy bleeding and other symptoms that require an immediate visit to the emergency room or calling 911. For a full list of medical emergencies, see <URL destination="https://www.nyp.org/ondemand/urgent-care/faqs-about-digital-urgent-care">www.nyp.org/ondemand/urgent-care/faqs-about-digital-urgent-care